Find care with UPMC Health Plan's Provider Directory. Visit our secure website, where network providers can sign in and complete most administrative tasks. for a doctor or specialist. Password: For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Search adult and pediatric providers and schedule appointments online. Contact Us Current Members. Get the latest resources, news, and announcements from UPMC Health Plan for participating providers. Find listings of the care providers we partner with including doctors, hospitals, pharmacies . // patched for y2k bug! View members' historical coverage information. Give us feedback on Provider OnLine. Paper Claim Submission: We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. If you need help with your account, please call 1-866-884-8579. Thousands of CE credits awarded online. The portal for UPMC patients in Central Pa. To request a direct interface of an 835 formatted ERA file, from this website or via PGP encrypted file transfer, please complete the 835 Request Form and send via email to HealthPlanEDI@upmc.edu. Watch and learn more about Provider OnLine, Appendix A COVID-19 Special Coverage and Payment Policy, NSA Negotiation Information for Providers, Provider Disclosure of Ownership and Control, Expedited Provider Appeal Certification Form, EPSDT Clinical and Operational Guidelines, Continuing Medical Education (CME) Resources, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. The provider's office can enter claims and verify if they have been accepted and are ready for adjudication. For patients of UPMC-affiliated doctors in Central Pa, select UPMC Central Pa Portal. I am a: Login. Children's Health Insurance Program: UPMC for Kids (CHIP) Dental Advantage Submit claim forms to: Sign in to UPMC Cole Connect Patient Portal. Forgot username or password? Find care with UPMC Health Plan's Provider Directory. However, some plan providers may have been added or removed from the list (and/or contact information may have changed) since this directory was last updated. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Provider OnLine Login Username Sign In If you forgot your user ID or need assistance, please call our Help Desk at 1-800-937-0438. Here you can explore resources and information about Medical Assistance coverage and benefits. Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. Learn about and take advantage of the resources available to you as a network provider. Call your provider's office or 1-800-533-8762. Login/Register. I am a: Login. How to Login? Existing EFT payments set up with MetLife will remain unchanged, so no action is required on your part. Providers. For Providers About Contact . Find care with UPMC Health Plan's Provider Directory. Learn how to get one now. Your place to stay in control. 2023 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences, Supplemental content provided by Healthwise, Incorporated. . As a network dentist, youll get help with claims status, eligibility, and more. Welcome to MetDental.com. Login/Register. More Contact Options ; . In order to submit EDI files directly to the Health Plan, providers must: UPMC Health Plan currently accepts dual provider identifiers. For help utilizing the provider web portal, registering, or requesting training, contact SKYGEN's Portal Services Team at dentalproviderportal@skygenusa.com or call 1-844-621-4576. This person will: If you have not accessed your Provider OnLine account in the past six months, your account may be disabled. Vision . Important: Please provide your National Provider Identifier (NPI) when prompted. Providers submitting claims through If your billing system transmits claims to UPMC via a clearinghouse please contact your vendor, or clearinghouse, for instructions on how to automate the processing of ERA's in an 835 format. View plansget vision and dental plan information prior to the member's visit. Via the Provider OnLine EDI tools, these batches can be viewed in several standard report formats. Electronically filed claims may be submitted in the following ways: Individual claim entry Find out how to apply for Dental HMO/Managed Care Plan^. Medical Assistance: Not a UPMC Central PA Portal Patient? Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. These claims are loaded into batches and immediately posted in preparation for adjudication. When care is coordinated, submit the referring provider NPI if available, as well as the name and UPIN. Advantage Dental Provider Portal We have moved! Medical . Sign in/Register I am a:MemberProviderEmployerProducer Sign In Please enter your username. Read Dental Announcements SIGN . If you forgot your user ID or need assistance, please call our Help Desk at 1-800-937-0438. Emdeon should use payer ID 25184. Providers may use the standard PGP encryption process in addition to the secure FTP, if additional data security is desired. Please submit the National Provider Identifier (NPI), along with the tax ID and the provider ID as assigned by UPMC Health Plan. UPMC Health Plan and SKYGEN Product Guide. UPMC Community HealthChoices Dental Allowance Request Form. Learn more about the Preferred DentistProgram and MetLife Dental Health Maintenance Organization (DHMO)/Managed Care Network^ and benefits like an increased patient base, continuing education at NO CHARGE, and more. So many helpful features. These resources, such as the Provider Manual, can assist you with administrative and practice needs. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Login This application is best viewed using Internet Explorer versions 6.0 and higher Login As Provider Network Login Name Password Home Forgot Password? As a network provider, you can: Verify eligibilitycheck plan status with a member's ID, full name, and date of birth. The Federal No Surprises Act within the Consolidated Appropriations Act of 2021 provides for out-of-network and balance billing protections for out-of-network Emergency, Air Ambulance, and certain services rendered at in-network facilities. Determine a patient's primary insurance coverage. Our clients of insurance companies, third-party administrators and various groups lease the DenteMax PPO network for use in their dental benefit plans in order to service their more than 20 million members nationwide. 2599 Wexford Bayne Road, Sewickley, PA 15143 (Map) 724-933-3700. Pharmacy . You may search for dentists by zip code, proximity, and type on the provider search tool above for any of the dental options. UPMC Health Plan and SKYGEN Clinical Criteria effective 12/18/2022. PO Box 1600 Dentistry - Find a Doctor | UPMC Need Care? Claim files are transmitted using a secure FTP process that does not require data encryption prior to transmission. TTY: 711. About the Electronic Remittance Advice Our provider portal solutions make business transactions fast, simple and convenient, including: Submission of dental claims and prior authorizations . Pittsburgh, PA 15230-1600, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. Message your doctor Send a private, secure message to your provider, anytime. UPMC Vision Advantage and UPMC Vision Care* make it easy for you to give your patients high-quality vision care and preventive services. For a medical emergency, call 911 or go to the nearest emergency department. Need to schedule by phone? We also treat serious dental issues to help you keep smiling. For nearly 30 yearsSKYGEN has been a trusted partner in a changing dental landscape, offering the tools and support you need to enhance your business while providing exceptional patient care. Access formsfind provider manuals, plan sheets, lab program forms . For additional information, please call SKYGEN Provider Services at 1-855-806-5193 or email providerservices@skygenusa.com. Log In to the Dental Advantage Provider Portal Announcements Get the latest updates from UPMC Health Plan. For a medical emergency, call 911 or go to the nearest emergency dept. UPMC Dental Advantage offers competitive rates, convenient tools, and rapid reimbursement. Forgot username or password? Account Login | MyUPMC Log In To Your Account Username Password Sign Up Forgot Username? For a medical emergency, call 911 or go to the nearest emergency dept. For a medical emergency, call 911 or go to the nearest emergency department. You can follow up with additional questions to the HealthPlanEDI@upmc.edu distribution group. Our Dental Benefits Advisory Team is ready to answer your call. Federal Employees: Federal Employees Health Benefits Program (FEHB) Dental Advantage Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Please sign in to view patient eligibility, The online provider search lets you find a person who provides . UPMC Dental Advantage Provider Portal Visit our secure website, where network providers can sign in and complete most administrative tasks. "January","February","March","April","May","June","July","August","September","October","November","December"); Submit claim forms to: *Disclaimer: This online directory provides a list of UPMC Health Plan providers, and the information contained here is updated periodically. First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. Dominion National provides dental plans and administrative services to UPMC Health Plan members and maintains an extensive selection of participating dentists. These clearinghouses are then responsible for reformatting these claims to meet HIPAA standards and passing the claims on to the Health Plan. . 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Don't have one? UPMC Dental Advantage offers UPMC employees two options Standard and Premium with a network of fully credentialed dentists. UPMC Health Plan's claims processing system allows providers to take advantage of enhanced access to information, including the ability to immediately correct claims that have missing information, incorrect procedure codes, or other errors. How to Login? Our provider portal solutions make business transactions fast, simple and convenient, including: Learn how SKYGEN's solutionsstreamline dental administration so you can focus on patient care. Dentists in our network enjoy top-notch support that makes it easier to run a successful practice. Complete testing and become certified with UPMC Health Plan. Serve as the provider practices primary contact with UPMC Health Plan regarding Provider OnLine security issues. Forgot Password? var now = new Date(); Login to Provider Online. Find out how to apply for the Preferred Dentist Program, Find out how to apply for Dental HMO/Managed Care Plan^, MetLife Dental Health Maintenance Organization (DHMO)/Managed Care Network^. Dental . You also can register to join the network. For Providers About Contact . Need to schedule by phone? If you have questions while you are completing the form, contact our Web Support Services at 1-800-937-0438. Resources for Medical Providers Dental Providers Learn about the dental products UPMC Health Plan offers and the variety of resources available to network providers. Medicare: UPMC for Life Dental Advantage (University of Pittsburgh retirees only) UPMC for You Dental Advantage Announcements Get virtual care Schedule a video visit with your regular provider. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Were happy to give you more information about becoming a UPMC Dental Advantage provider. For technical questions about the UPMC Central PA Portal, contact the Help Desk Mon. Register. Per HIPAA, the only permissible format for an electronic remittance advice (ERA), in a data file, is the ANSI ASC X12.835, Health Care Claim Payment/ Advice, commonly referred to as an 835. The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. Pittsburgh, PA 15213 DHMO providers will have the ability to manage all payments under one experience on the Zelis platform in future phases. Interested in joining UPMC Health Plans provider network? So can you. Forgot username or password? It is important that you respond to VPoint to ensure your continued relationship with MetLife. Please use the following link to return to the UPMC Health Plan home pageUPMC Health Plan home page Our provider portal is currently unavailable. To learn more, visit healthwise.org. As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. DHMO providers will continue to receive paper checks and/or EFT payments as they do today, no action is required for DHMO payments. Claims should be submitted using one of the methods below: Clearinghouse Submission: PO Box 1600 First-time users can create an account by contacting their office Provider OnLine Account Administrator or by calling 1-800-937-0438. Medicare Special Needs Plans: UPMC for Life Complete Care Dental Advantage. Find out how document.write(dayNames[now.getDay()] + ", " + monthNames[now.getMonth()] + " " + now.getDate() + ", " + year); User name: through Fri., 8 a.m. to 5 p.m. at 1-888-782-5678 or 717-988-0000 press 6 Find out how to apply for the Preferred Dentist Program Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. Get the latest news and information about the Dental HMO/Managed Care Network^ and Products. To verify eligibility and plan information, please call: Claims and pre-determinations should be submitted using one of the methods below: Clearinghouse Submission: Member Login. // Array of day names Have the ability to download and install a free Active-X secure FTP add-on. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. Providers who have existing relationships with clearinghouses such as WebMD (UPMC Health Plan Payer ID: 23281), NDC, and HDS can continue to transmit claims in the format produced by their billing software. Please be advised Zelis is the new payment solution for MetLife claim payments. View resources for medical providers, log into Provider OnLine, and get access to downloadable forms. Get the latest updates from UPMC Health Plan. Dental . Commercial and Medicare Home & Community-Based Services . Forgot Your dedicated network manager can answer questions and keep you current on new benefits, features, and products. MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. Get the latest news and information on the EFT/ERA Overview page in the resource center. Have a sample 837 file exported from their billing system containing only UPMC Health Plan claims. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. UPMC Dental Advantage Medicare Provider Services 1-844-761-0081 Claims and pre-determinations should be submitted using one of the methods below: Clearinghouse Submission: Providers submitting claims through Emdeon should use payer ID 23281. As a provider-led health insurer, we have a unique appreciation for our relationships with network doctors and care providers. If you need assistance, please call our Help Desk at 1-800-937-0438. First-time users can create a Provider OnLine account. Interact with the Health Plan on claims issues via a messaging system. Paper Claim Submission: Submit claim forms to: UPMC Dental Advantage PO Box 1600 Pittsburgh, PA 15230-1600 Our Provider Partner Update newsletter includes the latest news and information for network providers. UPMC Health Plan and SKYGEN Dental Provider Quick Reference Guide. Your Username or Password? If you choose this option for claims submission and you do not have a Provider OnLine account, complete this form to sign up. Call our scheduling team at 1-800-533-8762 between 8 a.m. and 5 p.m. Monday through Friday. User Login. Receive 24-hour access to claims and coverage information. Search adult and pediatric providers and schedule appointments online. Make Provider OnLine security requests to UPMC Health Plan on behalf of other staff members. For more information on dental services, view the UPMC Community HealthChoices Handbook . As a participating provider, you can access valuable information online by entering your user ID and password in the login box on this page. At this time, only PPO providers currently receiving their payments by checks will be included in this phase. Thank you for being a part of the UPMC Dental Advantage/UPMC Vision Advantage network. Grant access to Provider OnLine to certain staff members on the provider's behalf. While UPMC does offer the option to generate 835 formatted ERA files (and make them available for direct download via this website) many automated billing systems interface with payers via a clearinghouse. In the meantime, if you need to verify eligibility, plan information or submit a claim, please follow the instructions below. For a medical emergency, call 911 or go to the nearest emergency dept. Our dental health team at UPMC Cole offers high-quality family dental care at affordable pricing. UPMC Health Plan accepts electronic claims in data file transmissions. Search adult and pediatric providers and schedule appointments online. DenteMax is one of the largest leasable dental PPO networks in the United States. Not registered with UPMC Health Plan? The UPMC Presbyterian Dental Center at UPMC Montefiore offers preventive and follow-up dental care. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences. Participants who need help finding a dental provider, or have questions about their dental benefit, can call the UPMC Community HealthChoices HealthCare Concierge team at 1-844-833-0523 (TTY: 711). Need Help? The portal for all UPMC patients EXCEPT those in Central Pa. Visit UPMC Health Plan's homepage. Pittsburgh, PA 15230-1600. Select MyUPMC to access your UPMC health information. var year = now.getFullYear() UPMC Dental Advantage As the only provider-led health insurer in western Pennsylvania, we recognize the importance of partnership with network physicians and sensitivity to doctor-patient relationships. // Array of month Names Need to schedule by phone? Our Dental Advantage Newsletter includes the latest news and information for network providers. If you are interested in HIPAA-compliant EDI file submission, please refer to the additional set-up documents on this website. The Act creates specific negotiation and dispute resolution protocols between payer and provider. We are committed to offering industry-leading coverage to our memberssubject to federal, state, and local regulationsand to supporting our network providers as they deliver cost-effective, quality care. Discover the advantages of joining, and learn about resources available to you as a network provider. UPMC Health Plan and SKYGEN Provider Manual. Browse doctors by specialty, procedure, service, or equipment to find the best fit for you! Dental . If you forgot your User ID or need assistance, please call our Help Desk at 1-800-937-0438. For general assistance or inquiries regarding web portals or logins, please contact us here. For immediate help with a mental health crisis, call 988 for the Suicide & Crisis Lifeline. UPMC Community HealthChoices is one of the managed care organizations selected to provide Community HealthChoices (CHC) services in Pennsylvania to those who qualify for Medical Assistance and also qualify for Medicare or require a nursing facility level of care. Search adult and pediatric providers and schedule appointments online. You can request that your account be reactivated by contacting 1-800-937-0438. Submission of dental claims and prior authorizations, Member status and eligibility determination. plan detail, and claims. We offer personalized dental care at UPMC Montefiore in Pittsburgh and UPMC Cole in Coudersport and Port Allegany, Pa. Western Pa. Learn more about our plans and programs, find a dentist, or sign in to view patient eligibility, plan detail, and claims. Advantage Dental's Home Support Office is now located at 63140 Britta Street Suite D104, Bend, Oregon 97703 We will be making a few exciting system changes over the next several weeks to help improve provider and member experience! Dental Care at UPMC Our dental experts can help you to put your best face forward. Your session has ended, thank you for using UPMC Health Plan OnLine. For a medical emergency, call 911 or go to the nearest emergency department. Register. With UPMC Health Plan's Provider OnLine, you can: A provider office should appoint a staff member to serve as Security Officer. Behavioral Health . Provider OnLine Features With UPMC Health Plan's Provider OnLine, you can: Search adult and pediatric providers and schedule appointments online. *Administered by National Vision Administrators, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center. You also can register to join the network. to earn CE credits without leaving the office. Contact Our Dental Benefits Advisory Team, Join our UPMC Dental Advantage Provider Network, ONC 21st Century Cures Act Member Resource Center.